Healthcare Provider Details

I. General information

NPI: 1760496145
Provider Name (Legal Business Name): DEIRDRE DAVINA ELLIOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 LA JOLLA SCENIC DR S
LA JOLLA CA
92037-6445
US

IV. Provider business mailing address

4130 LA JOLLA VILLAGE DRIVE SUITE 301
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-3882
  • Fax: 858-452-3992
Mailing address:
  • Phone: 858-452-3882
  • Fax: 858-452-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG52738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: